Retractor apparatus

ABSTRACT

A frame includes a plurality of frame portions. Connecting means interconnects these frame portions for movement with respect to one another to define a substantially rectangular framework. Locking or latching means is associated with each of said connecting means for selectively locking or latching the frame portions in position with respect to one another, each of said locking or latching means including an outwardly extending manually engageable portion which can be readily operated. Support arms are also movably mounted with respect to the frame portions by connecting means, and similar locking or latching means are associated with such connecting means to lock or latch the support arms in position relative to the frame portions. Retractor blade means including a plurality of telescopic sections is connected to one end of the support arms.

United States Patent [1 1 [111 3,724,449 Gauthier {451 Apr. 3,1973

[54] RETRACTOR APPARATUS FOREIGN PATENTS OR APPLICATIONS 12,990 4/1928 Australia ..l28/20 [761 Invent will}!!! KEEP?" l fz 3 572,592 10/1945 Great Britain ..287/49 Codifer Boulevard. Metame. La.

70005 Primary Examiner-Lucie H. Laudenslager [22] Filed: Oct 19 1970 Att0rneyShoemaker and Mattare [57] ABSTRACT A frame includes a plurality of frame portions. Connecting means interconnects these frame portions for commuatwn-m-part 0f 873,051, 31, movement with respect to one another to define a sub- 1969 abandoned stantially rectangular framework. Locking or latching means is associated with each of said connecting [52] U.S. Cl ..128/20 means for selectively locking of latching the frame [51] Int. Cl. ..A6lb 17/02 portions in position with respect to one another, each [58] Field of Search ..l28/3, 20; 287/54 B, 49, 51 of said locking or latching means including an outwardly extending manually engageable portion which References Cited can be readily operated. Support arms are also movably mounted with respect to the frame portions UNITED STATES PATENTS by connecting means, and similar locking or latching 1,386,317 8/1921 Claasen ..ss so AT means are mated h i 1,435,433 11/1922 Triggs "851501" lock or latch the support arms in positionrelatn c to 1,707,689 4/1929 Sloan ..l28/20 the frame Retracm' blade means 3 3 255,721 5/1966 Patel-Schmidt U 287/54 B plurality of telescopic sections is connected to one end 3,522,799 8/1970 Gauthier ..l28/20 the PP arms- 23 Claims, 29 Drawing Figures 31m I m 62 T 6 I2 3%. ;]/-3s 1. ii 1 1 III, I, .t A 1 .J @F }I;'ZE 161 f;- 1

PATENTEDAPR3 1975 3,724,449

sum 2 OF 5 FIG.2.

IN TOR WILLIAM K.GAU ER ATTORNEYS PATENTED R ms 3.724.449

SHEET 3 [IF 6 20 22 \IOIV INVEN TOR WILLIAM K.GAUTHIER BY JMW W ATTORNEYS PATENTEUIPRB I975 3.724449 sum u 0P6 FIG. I8.

' INVENTOR WILLIAM K. GAUTHIER ATTORNEYS BY' 4 4 )i/ w PATENTEDAFRB m5 3.724449 SHEET 5 OF 6 INVENTOR WILLIAM K. GAUTHIER BY )Z/ I ATTORNEYS PATENTED B ms 3,724,449

SHEET 6 [IF 6 F/GZZ I v i 245 I l! IN \1 J I INVENTOR WILLIAM K. GAUTHIER BY%Z 1 ATTORNEYS RETRACTOR APPARATUS This application is a continuation in part of Ser. No. 873,051, filed Oct. 31, i969, and now abandoned.

BACKGROUND OF THE INVENTION The present invention relates to retractor apparatus for use, for example, in abdominal, thoracic or cardiac surgery to produce traction in any particular direction and which will properly retain the engaged tissues sur- 1 rounding an incision during the performance of surgery on a patient. Conventional retractor devices which are well known inthe prior art include means for positioning generally U-shaped hook or blade members inserted into an incision for holding the tissue in retracted position. These U-shaped hook members are fixed to the associated arms on which they are supported so that the position of these hook members cannot be varied to conform to the configuration of different shaped incisions.'The angular and vertical position of the hook members with respect to the associated support arms cannot be varied, and accordingly there is no way in which the position of a plurality of tissue-engaging retractor blades can be adjusted around all sides of an incision.

The hook or blade members employed in known prior art arrangements are undesirable since tissue necrosis often occurs'due to the fact that a relatively small area of contact is provided with the associated tissues, thereby concentrating the force supplied to the tissue. The rigid construction of the hook members further contributes to tissue necrosis since there is no flexibility built into the retractor structure.

The frame upon which the support arms for the retractor blades are mounted includes a plurality of frame portions which are movably mounted with respect to one another so as to enable adjustment of the size of the frame in accordance with the size of the incision in any particular operation. During the operation, it is often desirable to change the size of the frame and also the positioning of the support arms, and such changes should be possible in a quick and efficient manner with a minimum of effort on the part of the surgeon or his assistants. It is a particular objective of the present invention to provide a novel locking or latching means which enables the various members of the device, which are movably mounted with respect to one another, to be quickly and effectively manipulated and locked or'latched.

A plurality of support arms for retractor blade means are provided in the present invention, some of these support arms being supported above the frame and other support arms being supported below the frame. It is, accordingly, an objective of the invention to provide a retractor blade support arm construction which is reversible so that it can readily be employed either above or below the frame as the case may be.

It is additionally desirable to provide a retractor blade construction wherein not only the vertical position of the retractor blade means is automatically adjustable with relation to the curvature of the walls of the incision, but additionally the vertical dimension thereof is automatically adjustable within relatively wide ranges as to facilitate use of the retractor blade means with incisions of various depths. It is additionally desirable to provide a resilient means at the bottom portion of the retractor blade means so as to minimize damage to the engaged and depressed tissues.

2 SUMMARY OF THE INVENTION The frame of the present invention includes a plurality of frame portions, each of which has channel means formed therein which receive connecting members which connect the frame portions for movement relative to one another.

Locking or latching means is associated with each of the connecting members for selectively locking the 0 frame members in position with respect to one another.

Each locking means includes a pair of members having cooperating cam surfaces thereon, one of the locking members having a laterally extending manually engageable operating portion which may be readily engaged by a person and simply pushed in a proper direction to either lock or unlock the locking means in an expeditions manner. These outwardly extending operating portions are readily accessible to the surgeon at all times, whereby quick and easy locking and unlocking is afforded during an operation.

A plurality of support arms for retractor blade means are provided, each of these support arms being interconnected with one of the frame portions by a connecting means. Locking means identical with that employed for locking the frame portions to one another is employed with each of the support arms for locking the support arms in desired position relative to an associated frame portion.

Each of these support arms includes a removable hand grip portion and a removable depending portion at the opposite end thereof, whereby the intermediate portion of the supportarm which has an elongated channel formed in one side thereof may be reversed so as to enable the support arm to be employed either above or below the associated frame.

The retractor blade means of the present invention includes a plurality of retractor blade sections telescopically interconnected with one another along with detent means for automatically holding them in position relative to one another, as well as to automatically limit means for limiting relative movement of the sections with respect to one another. This automatic telescoping arrangement enables the depth of the retractor blade means to be varied within relatively wide limits.

In addition, a separate resilient insert may be provided at the lower end of the retractor blade means so as to minimize damage to engaged and/or depressed tissues.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a top view of an assembled retractor apparatus according to the present invention;

FIG. 2 is a sectional view taken substantially along line 2-2 of FIG. 1, looking in the direction of the arrows;

FIG. 3 is a sectional view taken substantially along line 33 of FIG. 2, looking in the direction of the arrows;

FIG. 4 is an exploded view illustrating the facing surfaces of the two locking members of the locking means;

FIG. 5 is a top perspective exploded view illustrating a first form of connecting member;

FIG. 6 is a view illustrating the manner of assembling one of the locking members with respect to the associated connecting member;

FIG. 7 is a view illustrating the manner in which the other of the locking members is in turn operatively connected with the associated connecting member;

FIG. 8 is a sectional view taken substantially along line 88 of FIG. I, looking in the direction of the arrows;

FIG. 9 is a sectional view taken substantially along line 9-9 of FIG. 8, looking in the direction of the arrows; 1

FIG. 10 is a sectional view taken substantially along line I10 of FIG. 8, looking in the direction of the arrows;

FIG. 11 is a view taken substantially along line ll 11 of FIG. 10, looking in the direction of the arrows;

FIG. 12 is a top perspective exploded view of another form of connecting member according to the present invention;

FIG. 13 is a top perspective view illustrating a support arm according to the present invention;

FIG. 14 is a sectional view on an enlarged scale taken substantially along line 14-14 of FIG. 13, looking in the direction of the arrows;

FIG. 15 is a top perspective exploded view illustrating the manner in which the support arm may be reversed;

FIG. 16 is an exploded view of a portion of the structure shown in FIG. 15;

FIG. 17 is a sectional view on an enlarged scale taken substantially along line l7l7 of FIG. 15, looking in the direction of the arrows;

FIG. 18 is a sectional view taken substantially along line 1818 of FIG. 17, looking in the direction of the arrows;

FIG. 19 is an enlarged sectional view through the end of a support arm and the associated retractor blade means shown in expanded position;

FIG. 20 is a sectional view taken substantially along line 2020 of FIG. 19, looking in the direction of the arrows;

FIG. '21 is a sectional view through the lower portion of a modified form of retractor blade means according to the present invention;

FIG. 22 is a view taken substantially along line 22 22 of FIG. 21, looking in the direction of the arrows;

FIG. 23 is a top perspective view of the resilient insert employed in the embodiments shown in FIGS. 21 and 22;

FIG. 24 is an exploded perspective view of a modified form of locking means;

FIG. 25 is a top perspective view of a modified connecting member for use in the locking means of FIG. 24 positioned on the top of the frame means;

FIG. 26 is a sectional view in elevation of the modified locking means in assembled relationship on top of a frame portion;

FIG. 27 is a view illustrating the order of assembly of the manually engageable member, retaining cup and washer on the connecting member;

FIG. 28 is a top perspective view of a further modified form of connecting member for use with the locking means of FIG. 24 positioned on the bottom of the frame means; and

FIG. 29 is a sectional view of the locking means assembled to the bottom of a frame portion.

DESCRIPTION OF THE PREFERRED I EMBODIMENTS Referring now to the drawings wherein like reference characters designate corresponding parts throughout the several views, as seen in FIG. I, the frame of the retractor device includes four similar frame portions indicated generally by reference numerals 10, 12, 14 and 16, which preferably are extrusions formed of a suitable material such as aluminum, stainless steel, plastic or the like. If formed of aluminum, the frame members and assembled contacting parts are preferably'coated with Teflon or similar organic plastic material to facilitate moving the parts relative to each other for adjustment purposes. Each of the frame portions is of substantially rectangular cross-sectional configuration and has a pair of substantially T-shaped channels formed therein. Frame portion 10 includes an upper face having an upwardly opening or facing channel 20 therein and a lower face having a downwardly opening or facing channel 22 therein. Frame portion 12 similarly includes an upwardly opening channel 24 and p a downwardly opening channel 26; and frame portion 14 includes an upwardly opening channel 28 and a downwardly opening channel 30, the cross-sectional configuration of these channels being seen in FIG. 2. In a similar manner, frame portion 16 is providedwith an upwardly opening channel 32 and a downwardly opening channel 34. i 7

Since the channels formed in each of the frame portions open through the opposite ends thereof, removable end caps 36 are provided on opposite ends of each of the frame portions to prevent the connecting members hereinafter described from sliding out through the open ends of the channels. Each of the end caps is provided with a depressed dimple 38 which retains the cap in operative position on the end of an associated frame portion.

The connecting members for connecting the variou frame portions together for movement with respect to one another and the locking means for selectively locking the various frame portions in operative relationship are identical at allfour corners of the frame as seen in FIG. I, and accordingly a description of the structure at one corner of the frame will suffice for all, similar reference characters being applied to the various connecting members and locking means.

The connecting means and locking means disposed at the lower lefthand corner of FIG. 1 are illustrated in FIGS. 2 7 inclusive. As seen in FIG. 5, a connecting member indicated generally by reference character 40 has a first large end 42 of substantially rectangular shape which fits snugly within the lower portion of channel 20 formed in frame portion 10. The connecting member includes an upwardly extending post portion 44 of reduced dimension which is substantially square in cross-sectional configuration and which, in turn, joins with a reduced post portion 46 of substantially circular cross-sectional configuration.

The opposite end 48 of the connecting member is also substantially rectangular in shape and fits snugly within the upper portion of channel 30 as seen in FIG. 2. End 48 of the connecting member has its long dimension extending at right angles to the long dimension of the end 42 thereof. The connecting member is of one solid member as shown. Connecting member 40 may be formed of any suitable material, such as plastic or the like.

When the connecting member is in its operative position as shown in FIG. 2, members and 14 are interconnected with one another for sliding movement with respect to one another. The interengagement of the connecting member with the frame portions will prevent relative rotation of the frame portions with respect to one another and will retain them at substantially right angles to one another.

Referring now to FIGS. 4, 6 and 7, the locking means includes a pair of locking members indicated generally by reference numerals 60 and 62. Each of members 60 and 62 is of substantially circular plan configuration as seen in FIG. 4, and locking member 60 includes a central hole 64 formed therethrough of substantially square cross-sectional configuration. An elongated entry slot 66 extends from the outer periphery of locking member 60 inwardly and intersects hole 64. A clearance cut-out 68 is provided in locking member 60 adjacent to the entry slot 66 thereof.

The thickness of locking member 60 is at a minimum at point 70 as seen in FIG. 4 and increases in a clockwise direction to a maximum thickness at a point 72. Accordingly, the upwardly facing surface of locking member 60 as seen in FIG. 4 defines a cam surface, this surface having a plurality of radially extending serrations 74 formed therein.

Locking member 62 has a central hole 80 formed therethrough of substantially circular cross-sectional configuration. An elongated entry slot 82 extends inwardly from the outer periphery of locking member 62 and intersects hole 80. As seen in FIG. 4, locking member 62 has aminimum thickness at point 84, the

thickness of the locking member increasing in a clockwise direction to a maximum thickness at point 86. It should be understood that in the assembled position as shown in FIG. 2, locking member 62 is inverted from the position shown in FIG. 4 so that the upwardly facing surface of locking member 62 as seen in FIG. 4 is disposed in a downward direction, this surface also forming a cam surface which cooperates with cam surface formed on locking member 60. The cam surface on locking member 62 has a plurality of radially extending serrations 88 formed therein, these serrations cooperating with the serration 74 formed on locking member 60 for positively holding the two locking members in desired operative relationship with respect to one another.

Locking member 60 includes a laterally extending manually engageable operating portion 90, this operating portion extending a substantial distance outwardly so as to be readily engaged by the fingers of a surgeon, whereby the various locking means of the invention may be manipulated in a most effective manner.

It will be apparent that relative rotation of locking members 60 and 62 will cause them to be moved apart due to the coaction of the cam surfaces thereof so as to tightly wedge these locking members against the associated components of the retractor apparatus, thereby securely locking the engaged components with respect to one another. The locking means at the four corners of the frame means, of course, are adapted to securely lock the various frame portions in position with respect to one another. It is also evident that when it is desired to readjust the relative position of the components, the locking means can be readily unlocked simply by grasping the operating member and turning it in an appropriate direction.

As seen in FIG. 6, the reduced portion 46 of the post of the connecting member is received within the entry slot 66 formed in locking member 62. The clearance cut-out 68 enables the locking member to be slid laterally into position such that the central hole 64 thereof is over the portion 44 of the post of the connecting member, whereupon locking member 60 can be dropped downwardly into the final phantom line position as shown in FIG. 6.

Referring now to FIG. 7, locking member 62 is moved into operative position by moving it laterally so that the entry slot 82 thereof receives the reduced portion 46 of the post on the connecting member. When locking member 62 has been moved into a central position, the circular hole 80 thereof will be disposed over portion 44 of the post, whereupon locking member 62 can be dropped downwardly into the phantom line position shown in FIG. 7. Hole 62 formed through locking member 82 is sufficiently large to provide clearance with respect to portion 44 of the post, whereby locking member 62 can be rotated with respect to the post, while locking member 60 cannot be rotated with respect to the post since a central hole 64 thereof snugly receives the enlarged portion 44 of the post.

Referring now to FIG. 12, the connecting member indicated generally by reference numeral is' provided for use with the support arms mounted above an associated frame portion. This connecting member includes an enlarged end 102 having a width W equal to the width of the small portion of a channel opening through one of the frame portions, whereby enlarged end 102 can be inserted downwardly through the open part of such a channel and then turned so as to lock the connecting member in place within the channel as seen, for example, in FIG. 9. The enlarged head 102 of the connecting member has both end portions thereof downwardly tapered or inclined.

Connecting member 100 is a solid one-piece member and includes a post portion 106 of reduced dimension which is substantially square in cross-sectional configuration which, in turn, joins with a further reduced portion 108 which is substantially circular in cross-sectional configuration. The opposite enlarged end 110 of the connecting member is substantially circular in cross-sectional configuration and is integral with member 108. The connecting member may be formed of any suitable material such as plastic or the like.

Locking means similar to that previously described is provided in association with each of connecting members 100. Locking member 62 is identical with that previously described, and locking member 60' is substantially identical with locking member 60, with the exception that a rib is formed on the undersurface thereof seen most clearly in FIG. 11. This rib is interrupted at the central part thereof to provide the central hole 64 through locking member 60' corresponding to hole 64 previously described. The remaining portions of locking member 60' similar to portions of locking member 60 have been given the same reference numerals primed.

Rib 120 is snugly received within the smaller portion of the T-shaped channel formed in frame portion 10 as seen in FIG. 10, whereby relative rotation between locking member60' and frame portion 10 is positively prevented. Accordingly, rotation of locking member 62 will cause relative rotation between the two locking members to thereby cause locking or unlocking of the associated support arm with respect to the frame portion as the case may be.

A part 130 of a support arm is illustrated, this part of the support arm having a T-shaped channel 132 formed therethrough, the enlarged part of this T-shaped channel snugly receiving the disc-like enlarged end 110 of the connecting member, whereby part 130 of the connecting arm is adapted to turn with respect to the connecting member when the associated locking means is in the unlocked position.

Referring now to FIGS. 24 through 27, a modified form of locking means and connecting member are illustrated. The locking means 231 comprises an upper locking member 232 having a generally circular plan configuration with a pair ofupstanding diametrically opposite lugs 233 and 234 thereon. An entry slot 235 extends radially through one side of the locking member to the center thereof and terminates at its inner end in a rounded end defining a central opening 236 in the locking member. The bottom surface of the locking member 232 includes a cam surface similar to the cam surface described in relation to the locking member illustrated in FIGS. 2 through 7 and increases in thickness in a counterclockwise direction from one side of the entry slot 235 to the other side thereof. A plurality of radially extending serrations are formed in the cam surface 237 and define a plurality of ratchet type teeth 238. A bottom locking member 239 having a generally circular plan configuration also includes a cam surface 240 thereon and an entry slot 241 extending through one side of the locking member to a central opening 242 having a generally circular cross-sectional configuration in the center of the locking member. The cam surface 240 increases in thickness in a clockwise direction from one side of the entry slot 241 to the other side thereof and has a plurality of ratchet teeth 243 thereon extending in the opposite direction from the teeth 238 on the upper locking member 232 and adapted to cooperate therewith to lock the locking members 232 and 239 together against relative rotation therebetween. A clearance notch 243 extends parallel and adjacent to the entry slot 241 for a purpose identical to the clearance notch 68 in locking member 60, previously described. A laterally extending manually engageable operating arm 244 extends from the periphery of the locking member 239 adjacent the entry slot 241.

If desired, locking members 232 and 240 may be formed from similar or dissimilar materials as desired to increase the wear characteristics of these parts. Similarly, the parts 60 62 can be so formed if desired.

A generally cup-shaped retaining member 245 having substantially a circular plan configuration and an annular peripheral upstanding wall 246 thereon for receiving a resilient friction reducing washer 247 of Teflon, silicone rubber or the like is adapted to be disposed in underlying relationship to the locking member 239. The retaining member 245 has a central opening 248 therein having a generally circular crosssectional configuration and an entry slot 249 extending through one edge of the retaining member to the central opening 248.

A connecting member position control element 250 has a disc-shaped portion 251 with a central opening 252 therethrough having a generally square cross-sectional configuration. An entry slot 253 extends from one edge of the disc 251 to the central opening 252 and a manually engageable operating arm 254 extends from one edge of the disc 251.

A connecting member 255 (FIGS. 25 and 26) has a generally elongate locking element 256 at one end thereof having generally wedge-shaped opposite end portions 257 and 258. A first post or shaft portion 259 extends upwardly from the elongate member 256 and has a generally circular cross-sectional configuration. A second post or shaft portion 260 adjacent the first post portion is diametrically enlarged and has a generally square cross-sectional configuration. A third post or shaft portion 261 adjacent the second post or shaft portion has a reduced diameter relative to the second shaft portion but is larger in diameter than the first shaft portion and has a generally circular crosssectional configuration. A fourth post or shaft portion 262 is adjacent the third shaft portion and has a reduced diameter relative to the third shaft portion and has a generally circular cross-sectional configuration. A diametrically enlarged retaining button 263 is formed at the end of the connecting member opposite the elongated locking member 256 and has a generally circular cross-sectional configuration.

The locking means 231 is assembled to the connecting member 255 in a manner similar to that in which the previously described locking means is assembled to the connecting member 40 in that the post portions are received through the entry slots in the respective elements of the locking means and the respective elements are then moved axially of the post portions to their respective operative positions with the teeth 238 on locking member 232 in facing operative engagement with the teeth 240 on locking member 239.

As seen particularly in .FIG. 26, the retaining button 263 on connecting member 255 is received within T- shaped channel 132 in the retractor arm and the elongate locking member 256 is received within the T- shaped channel 20 in the frame portion 10. The lugs 233 and 234 on the locking member 232 extend into the channel 132 to prevent relative rotation between the locking member 232 and the retractor arm 130. The square portion 260 of the post on the connecting member is received in complementary engagement within the opening 252 in the position control member 250, whereby manipulation of the arm 254 will cause the connecting member to be rotated and the opposite ends 257 and 258 of the elongate member 256 brought into engagement with the sides of the channel 20 in frame portion 10. The operating arm 244 on looking member 239 is then manipulated causing the cam surfaces 237 and 240 to move relative to one another wedging the locking member 232 and 239 apart relative to one another to lock the retractor arm 130 to the frame portion 10 in a manner similar to that previously described. The ratchet-type teeth 238 and 240 and the resilient friction reducing washer 247 enables the locking members to be readily moved with respect to one another and at the same time provide a secure locking engagement between the parts. The elongate member 256 has a width W less than the width of the opening to channel 20 so that the connecting member and an associated retractor arm may be readily inserted in and removed from the T-shaped channel 20, whereby the surgeon may quickly and easily add or remove retractor arms to the top of the frame as required.

A slightly modified form of locking means and connecting member is illustrated in FIGS. 28 and 29. This form of the invention is substantially identical with the form of the invention described in relation to FIGS. 24 through 27, except that the position control member 250 is eliminated and the square section 260 on the shaft of the connecting member is also eliminated. Further, whereas the invention described in relation to FIGS. 24 through 27 is intended to be positioned on the top of the frame for ready addition and removal of retractor arms to and from the frame as desired, the invention described in relation to FIGS. 28 and 29 is intended to be positioned on the underside of the frame 10 as seen in FIG. 29 and is not intended to be removed from the frame while in use since the enlarged retaining button 263 is received within the channel 20. The elongate locking member 256 is replaced with an enlarged retaining button 264 which is received within the T-shaped channel 132 in the retractor arm 130. Further, the locking members 232 and 239 are inverted from their positions shown in FIG. 24. In all other respects, the operation and function of the locking means and connecting member illustrated in FIGS. 28 and 29 is the same as that of the locking means and connecting member illustrated in FIGS. 24 27.

While the locking means 231 is described specifically for use with the retractor arm 130, it should be understood that the locking means 231 can replace the locking means 62 positioned at the ends of the respective frame members to maintain same in fixed operative position.

As seen in FIG. 13, a support arm indicated generally by reference numeral 140 includes the part 130 previously described. As seen in FIG. 1, a pair of such support arms 140 are supported at spaced points on frame portion 10 and above the frame portion so as to support retractor blade means within an incision indicated by reference character I. Support arms 140 are adapted to carry retractor blade means which engage internal organs, such as bowels B in the case of the abdominal incision, or retract the wall of the incision, support arms 140 being angularly adjustable with respect to frame portion 10 and then locked in position as aforedescribed.

A similar pair of support arms 140a are illustrated in FIG. 1, these support arms having the part 130 thereof inverted from the position of support arms 140. Support arms 140a are adapted to hold the incision open or hold internal organs, and are disposed beneath frame portions 10 and 12. Accordingly, in the case of support arms 140a, a connecting member, as shown in FIG. or FIG. 12, may be employed since these support arms remain at right angles to the associated frame portions which would allow for variable angles of 140a in relation to frame 16. The locking means, of course, may be identical with the locking means employed for holding the four corners of the frame in operative relationship when the device shown in FIG. 5 is usedor locking means in FIGS. 8, 9, 10 and 11.

Referring again to FIG. 13 of the drawings, support arm includes a removable hand grip portion 144 having a tubular portion 145 of substantially rectangular cross-sectional configuration which receives one end of part 130 of the support arm. The hand grip portion is removably secured to part 130 by a screw 146, extending through suitable aligned threaded holes provided in part 130 and the hand grip portion.

A removable depending portion also includes a tubular portion of substantially rectangular cross-sectional configuration for receiving the opposite end of part 130, part 130 and the depending portion being removably secured to one another by a screw 152 ex tending through suitable aligned threaded holes formed in part 130 and portion 150.

FIG. 13 illustrates the support arm in assembled relationship for support above an associated frame portion, and FIG. 15 illustrates the manner in which part 130 can be inverted when it is desired to support the support arm beneath an associated frame portion.

Member 130 as well as the removable hand grip portion 144 and the depending portion 150 are all preferably formed of a suitable strong and light weight material such as aluminum or the like.

Depending portion 150 of the support arm includes a downwardly extending substantially cylindrical pivot shaft 154 which, as seen in FIG. 14, has a peripherally extending groove 156 formed in the lower end thereof.

A blade means support portion 160 is supported for automatic rotation on shaft 154 in relation to the cavity wall and includes a substantially cylindrical bore 162 which receives shaft 154, an elongated slot 164 being formed in member 160 and intersecting bore 162.

An annular bead 166 projects inwardly into bore 162 and fits snugly within groove 156 formed in shaft 154, whereby member 160 can be snapped into operative position as illustrated in FIG. 14 so that it will be retained on shaft 154 and yet may rotate with respect thereto.

As seen in FIGS. 13 and 15, member 160 includes a substantially arcuate face 168 which is complementary to the retractor blade hereinafter described.

Referring now to FIGS. 16 18 inclusive, a modified manner of supporting the blade means support portion on shaft 154 of the support arm is illustrated. The blade means support portion 160 includes a substantially cylindrical bore which receives shaft 154 of the support arm, and member 160' is provided with a substantially arcuate face 168'.

A slot 170 is formed through member 160' and intersects bore 162'. A snap ring 172 fits through slot 170 and is disposed within a peripheral groove 156' formed in the lower end of shaft 154. Groove 156' may be modified so as to be of substantially rectangular crosssectional configuration so as to snugly receive snap ring 172, whereby member 160' is retained in operative position on shaft 154 and yet may rotate with respect thereto.

Referring now to FIGS. 19 and 20, the retractor blade means supported by the support arm and the blade means support portion 160 is illustrated. The

retractor blade means includes a plurality of sections which are disposed in automatic telescopic relationship with respect to one another, each of these sections being generally arcuate to define an arcuate face for engaging tissues and organs of a patient automatically determining the proper depth of the blade in the cavity. Detent means is provided for automatically holding the retractor blade sections in different relative positions with respect to one another, and limit means is provided for limiting relative movement of the retractor blade sections with respect to one another.

The first retractor blade section 180 includes inwardly directed flanges 182 at the opposite vertical edges thereof for embracing blade means support portion 160 to automatically slidably support retractor blade section 180 on member 160. As seen in FIG. 19, the lower end of blade means support portion 160 includes a laterally extending portion 176 which is adapted to engage automatically with cooperating detent portions on the retractor blade section to'hold the retractor blade section in position thereon.

Section 180 includes a plurality of vertically spaced detent portions or ribs 184 which are adapted to engage part 176 of blade means support portion 160 for holding section 180 in a predetermined or automatically adjustable vertical position relative to blade 160. A laterally inwardly extending flange 186 extends laterally from the upper edge of section 180 and is adapted to engage part 176 of portion 160 to positively limit downward movement of section 180 with respect to portion 160. A laterally outwardly extending flange 188 is formed at the bottom edge of section 180.

A second blade section 190 similar to blade section 180 is provided, blade section 190- being sufficiently larger than section 180 so as to automatically telescopically receive section 180. Section 190 includes a pair of inwardly directed flanges 192 at the opposite vertical edges thereof, flanges 192 embracing and engaging the aforedescribed flanges 182.

Section 190 is provided with 'a plurality of vertically spaced detents or ribs 194 similar to detents 184 previously described. A laterally inwardly extending flange 196 is provided at the upper edge of section 194, and a laterally outwardly extending flange 198 is provided at the lower edge of section 190.

Detents 194 in section 190 cooperate with flange 188 formed on section 180 to retain section 190 in a predetermined vertical relationship with respect to section 180. In addition, flange 196 formed on section 190 is adapted to engage flange 188 formed on section 180 so as to positively limit downward movement of section 190 with respect to section 180.

A further retractor blade section 200 is provided, the dimensions of this section being sufficient to telescopically receive section 190. Section 200 is provided with inwardly directed flanges 202 provided along the vertical edges thereof and embracing and engaging flanges 192 previously described.

Section 200 is provided with a plurality of vertically spaced detents or ribs 204 which are adapted to engage flange 198 formed on section 190 to retain section 200 in predetermined vertical position with respect to section 190.

Section 200 is provided with a laterally inwardly extending flange 206 at the upper edge thereof which is adapted to engage flange 198 formed on section to positively limit downward movement of section 200 with respect to section 190.

The lower edge 210 of section 200 is-rolled over so as to provide a resilient portion for engaging and/or depressing tissue and organs of a patient so as to provide a resilient construction to minimize damage to the patient.

Referring now to FIGS. 21 23 inclusive, a modified form of the invention is illustrated wherein the lowermost retractor blade section 200' is similar to section 200, and similar parts have been given the same reference numerals primed. Section 200' includes a resilient insert such as a tubular portion 220 at the lower end thereof defining a channel of any shape for receiving a resilient insert. An elongated slot 222 is formed through tubular portion 220.

As seen most clearly in FIG. 23, the resilient, solid, hollow or any desired insert is indicated generally by reference numeral 224 and may be formed of any suitable material such as rubber, plastic or-the like. This insert includes a pair of tubular portions 226 and 228 interconnected by an integral web 230.

The insert may be slipped into the operative position shown in FIGS. 21 and 22 wherein tubular portion 226 is received withintubular portion 220 of the retractor blade section, and the web portion 230 of the insert extends through slot 222 formed in tubular portion 220.

As this invention may be embodied in several forms without departing from the spirit or essential characteristics thereof, the present embodiment is therefore illustrative and not restrictive, since the scope of the invention is defined by the appended claims rather than by the description preceding them, and all changes that fall within the metes and bounds of the claims or that form their functional as well as conjointly cooperative equivalents, are therefore intended to be embraced by those claims.

What is claimed is:

1. A surgical retractor including a rigid frame means defining a central, enlarged opening, said frame means having opposite faces thereon, a longitudinally'extending channel in each face, at least one elongate retractor blade support arm adjustably secured on said frame means and having a longitudinally extending channel therein, the channel in said support arm being in confronting relationship with one of the channels in said frame means, retractor blademeans secured on one end of said support arm for engaging tissue at the edge of a surgical incision for holding the tissue in a retracted position, and connecting means interconnecting the support arm to the frame means, said connecting means having opposite enlarged ends interconnected by a reduced diameter post portion, the enlarged ends-received in a respective adjacent channel of the frame means and the support arm, a pair of discshaped latching members around said post portion between the frame means and support arm, said latching members having confronting, interengaged, serrated, spiral shaped cam surfaces thereon, one of said latching members fixed against rotation relative to the frame means, radially projecting manually operable means on the other latching member so that said other latching member can be rotated about the axis of said post portion, so that said cam surfaces cause said latching members to wedge between the support arm and frame means to securely hold the support arm in adjusted position on the frame means.

2. Apparatus as defined in claim 1, wherein said post portion is of non-circular cross-sectional configuration.

3. Apparatus as defined in claim 2, wherein said post portion includes a reduced circular portion.

4. Apparatus as defined in claim 1, wherein each of said latching members includes an entry slot extending from the center thereof through one edge whereby the latching member can be placed in operative position with respect to one of said connecting means.

5. Apparatus as defined in claim 4, wherein one of said locking members includes a clearance cut-out adjacent said entry slot.

6. Apparatus as defined in claim 1, wherein one of said latching members includes a rib thereon engaged in an adjacent channel of the frame for preventing relative rotation of such latching member with respect to the frame.

7. Apparatus as defined in claim 1, wherein said support arm includes a removable hand grip portion at one end thereof.

8. Apparatus as defined in claim 1, wherein said support arm includes a removable depending portion at one end thereof.

9. Apparatus as defined in claim 8, including an arcuate blade means support portion freely rotatably mounted on the depending portion of said support arm.

10. Apparatus as defined in claim 9, wherein said blade means support portion has an open slot for receiving said depending portion of the support arm which snaps into place within said open slot. 7

11. Apparatus as defined in claim 9, wherein said depending portion of the support arm has a groove formed therein, said blade means support portion having a slot formed therein, a snap ring extending through said slot and being positioned in said groove for holding said blade means support portion in operative position.

12. Apparatus as defined in claim 1, wherein said retractor blade means includes a plurality of individual sections mounted for movement with respect to one another, each of said retractor blade sections being of substantially areuate cross-sectional configuration.

13. Apparatus as defined in claim 12, wherein said retractor blade sections are disposed in telescopic relationship with respect to one another.

14. Apparatus as defined in claim 13, wherein said retractor blade sections have cooperating detent means thereon for automatically holding them in varying depths according to the different individual body cavities in operative positions with respect to one another.

15. Apparatus as defined in claim 13, including limit means for limiting relative movement of said retractor blade sections with respect to one another.

16. Apparatus as defined in claim 1, wherein said retractor blade means has an upper end and a lower end when in use, and said retractor blade means is resilient at the lower end thereof.

17. Apparatus as defined in claim 16, wherein the lower end of said retractor blade means has a channel formed therein, and a resilient insert is positioned within said channel.

18. Apparatus as defined in claim 1, wherein resilient friction reducing means is disposed between said disc portion and an adjacent one of said latching members to facilitate relative rotation therebetween.

19. Apparatus as defined in claim 1, wherein the frame latching means, support arm and connecting means are coated with a friction reducing organic plastic coating.

20. Retractor apparatus as in claim 1, wherein at least one of said enlarged ends is elongated in a direction perpendicular to the axis of said post portion, and said latching means includes means cooperatively engaged with part of said post portion to rotate said post portion and said one enlarged end to wedge the enlarged end against the sides of the channel in which it is received.

21. Retractor apparatus as in claim 1, wherein at least one of said enlarged ends on said connecting means has a circular configuration, thus enabling said retractor blade support arm to be angularly adjusted relative to an associated frame member in the plane of the frame member.

22. A surgical retractor as in claim 1, wherein said frame means comprises a plurality of elongate, rigid frame members releasably and adjustably connected together.

23. A surgical retractor as in claim 22, wherein each frame member has opposite faces thereon and a longitudinally extending channel is in each face, connecting means adjustably connecting adjacent frame members together with the channel in one face of each frame member in confronting relationship to the channel of an adjacent frame member, said connecting means having opposite enlarged ends interconnected by a reduced diameter post portion, the enlarged ends received in a respective adjacent channel of a pair of adjacent frame members, a pair of disc-shaped latching members around said post portion between the frame members, said latching members having confronting, interengaged, serrated, spiral shaped cam surfaces thereon, one of said latching member fixed against rotation relative to the frame members, radially projecting manually operable means on the other latching member so that said other latching member can be rotated about the axis of said post portion, so that said cam surfaces cause said latching members to wedge between the confronting faces of adjacent frame members to securely hold the frame members in adjusted position relative to one another. 

1. A surgical retractor including a rigid frame means defining a central, enlarged opening, said frame means having opposite faces thereon, a longitudinally extending channel in each face, at least one elongate retractor blade support arm adjustably secured on said frame means and having a longitudinally extending channel therein, the channel in said support arm being in confronting relationship with One of the channels in said frame means, retractor blade means secured on one end of said support arm for engaging tissue at the edge of a surgical incision for holding the tissue in a retracted position, and connecting means interconnecting the support arm to the frame means, said connecting means having opposite enlarged ends interconnected by a reduced diameter post portion, the enlarged ends received in a respective adjacent channel of the frame means and the support arm, a pair of disc-shaped latching members around said post portion between the frame means and support arm, said latching members having confronting, interengaged, serrated, spiral shaped cam surfaces thereon, one of said latching members fixed against rotation relative to the frame means, radially projecting manually operable means on the other latching member so that said other latching member can be rotated about the axis of said post portion, so that said cam surfaces cause said latching members to wedge between the support arm and frame means to securely hold the support arm in adjusted position on the frame means.
 2. Apparatus as defined in claim 1, wherein said post portion is of non-circular cross-sectional configuration.
 3. Apparatus as defined in claim 2, wherein said post portion includes a reduced circular portion.
 4. Apparatus as defined in claim 1, wherein each of said latching members includes an entry slot extending from the center thereof through one edge whereby the latching member can be placed in operative position with respect to one of said connecting means.
 5. Apparatus as defined in claim 4, wherein one of said locking members includes a clearance cut-out adjacent said entry slot.
 6. Apparatus as defined in claim 1, wherein one of said latching members includes a rib thereon engaged in an adjacent channel of the frame for preventing relative rotation of such latching member with respect to the frame.
 7. Apparatus as defined in claim 1, wherein said support arm includes a removable hand grip portion at one end thereof.
 8. Apparatus as defined in claim 1, wherein said support arm includes a removable depending portion at one end thereof.
 9. Apparatus as defined in claim 8, including an arcuate blade means support portion freely rotatably mounted on the depending portion of said support arm.
 10. Apparatus as defined in claim 9, wherein said blade means support portion has an open slot for receiving said depending portion of the support arm which snaps into place within said open slot.
 11. Apparatus as defined in claim 9, wherein said depending portion of the support arm has a groove formed therein, said blade means support portion having a slot formed therein, a snap ring extending through said slot and being positioned in said groove for holding said blade means support portion in operative position.
 12. Apparatus as defined in claim 1, wherein said retractor blade means includes a plurality of individual sections mounted for movement with respect to one another, each of said retractor blade sections being of substantially arcuate cross-sectional configuration.
 13. Apparatus as defined in claim 12, wherein said retractor blade sections are disposed in telescopic relationship with respect to one another.
 14. Apparatus as defined in claim 13, wherein said retractor blade sections have cooperating detent means thereon for automatically holding them in varying depths according to the different individual body cavities in operative positions with respect to one another.
 15. Apparatus as defined in claim 13, including limit means for limiting relative movement of said retractor blade sections with respect to one another.
 16. Apparatus as defined in claim 1, wherein said retractor blade means has an upper end and a lower end when in use, and said retractor blade means is resilient at the lower end thereof.
 17. Apparatus as defined in claim 16, wherein the lower end of said retractor blade means has a channel formed therein, and a resilient insert is positioned within said channel.
 18. Apparatus as defined in claim 1, wherein resilient friction reducing means is disposed between said disc portion and an adjacent one of said latching members to facilitate relative rotation therebetween.
 19. Apparatus as defined in claim 1, wherein the frame latching means, support arm and connecting means are coated with a friction reducing organic plastic coating.
 20. Retractor apparatus as in claim 1, wherein at least one of said enlarged ends is elongated in a direction perpendicular to the axis of said post portion, and said latching means includes means cooperatively engaged with part of said post portion to rotate said post portion and said one enlarged end to wedge the enlarged end against the sides of the channel in which it is received.
 21. Retractor apparatus as in claim 1, wherein at least one of said enlarged ends on said connecting means has a circular configuration, thus enabling said retractor blade support arm to be angularly adjusted relative to an associated frame member in the plane of the frame member.
 22. A surgical retractor as in claim 1, wherein said frame means comprises a plurality of elongate, rigid frame members releasably and adjustably connected together.
 23. A surgical retractor as in claim 22, wherein each frame member has opposite faces thereon and a longitudinally extending channel is in each face, connecting means adjustably connecting adjacent frame members together with the channel in one face of each frame member in confronting relationship to the channel of an adjacent frame member, said connecting means having opposite enlarged ends interconnected by a reduced diameter post portion, the enlarged ends received in a respective adjacent channel of a pair of adjacent frame members, a pair of disc-shaped latching members around said post portion between the frame members, said latching members having confronting, interengaged, serrated, spiral shaped cam surfaces thereon, one of said latching member fixed against rotation relative to the frame members, radially projecting manually operable means on the other latching member so that said other latching member can be rotated about the axis of said post portion, so that said cam surfaces cause said latching members to wedge between the confronting faces of adjacent frame members to securely hold the frame members in adjusted position relative to one another. 